2009 Chief Resident Development Conference: Caring for Your Residents Roseanne C. Berger, MD Senior Associate Dean for Graduate Medical Education & ACGME Designated Institutional Official (DIO) for UB

Goal: Support residents experiencing problems that impede learning.  Fatigue  Academic Difficulty  Harassment  Impairment

Warning Signs

Selected Warning Signs  Deteriorating personal hygiene  Unfocused, confused, distracted  Mood swings  Unprofessional demeanor or conduct  Anger/Abusive Language  Frequent lateness, absence or illness  Isolation: avoidance of associates  Inappropriate response to patient needs or staff requests  Ignoring requests to catch up on paperwork  Uncooperative and defiant approach to problems and/or performance feedback

Impairment/Substance Abuse  Signs & symptoms of impairment  Report to PD or GME – do not handle yourself  Encourage individual to self-report to GME or Committee on Physician’s Health (CPH)  Treatment options Coincident with training Coincident with training Leave of Absence – up to 3 months Leave of Absence – up to 3 months

1 (800) or (518) The Committee for Physician Health 99 Washington Avenue, Suite 410 Albany, NY Fax: (518) All calls are CPH Contact Info

Harrassment/Discrimination  Sexual or other forms  Sexual or other forms  If possible, tell harasser to stop  Discuss with PD, Chair, DIO, Office of Equity, Diversity, and Affirmative Action  ubuffalo/ ubuffalo/ ubuffalo/

UB/GME Resources  Susan Orrange, M.Ed.  Roseanne Berger, M.D.  Chief Resident Listserv  Policies on Impairment, Harassment, and Academic Status  Common Program Requirements Common Program Requirements RRC Requirements for your program RRC Requirements for your program  The Joint Commission

LIFE Curriculum (Learning to Address Impairment and Fatigue to Enhance Patient Safety)  Self-directed learning modules in the areas of: Fatigue Fatigue Disruptive Physicians Disruptive Physicians Stress & Depression Stress & Depression Substance Abuse Substance Abuse Burnout Burnout Impairment Impairment Negative Feedback Negative Feedback

UB Human Resources  Work/life balance UB Employee discounts UB Employee discounts Fitness centers, theme parks & attractions, software, wireless phones, moving services, and moreFitness centers, theme parks & attractions, software, wireless phones, moving services, and more  Learning & Development Registration & Course Catalog Registration & Course Catalog Short courses in Career and Personal Development, Software and Computer Productivity, Wellness & Worklife BalanceShort courses in Career and Personal Development, Software and Computer Productivity, Wellness & Worklife Balance Over 1,000 online, self-directed learning modules (Skillsoft)Over 1,000 online, self-directed learning modules (Skillsoft)

Assignment Read and Discuss the case scenarios and answer the following questions. 1. What is your differential diagnosis? 2. What questions would you ask to confirm your hypothesis? 3. What is your plan to assist this resident? How will you assess if it is effective? 4. How would you address the situation with the residency program director?

Case 1: Dr. X recently transferred into your program. You learn she was treated for substance abuse during a stressful divorce. She is soft spoken, hard working, and well liked but appears anxious when presenting cases and is not organized or focused. The faculty question her ability to “cut it” and critique her judgment in front of others.

Case 1 continued Evaluations do not include comments. Most raters circled “3” on a 5-point scale for medical knowledge and patient care and 4-5 for professionalism and communication skills. The resident says faculty have not spoken to her about her performance. The resident says faculty have not spoken to her about her performance.

Case 2:  Dr. Y is never able to finish their work. He comes in early and stays late to keep up. BFH (Buffalo’s Finest Hospital) is cracking down on this behavior and even asked the residents to sign an attestation saying they would be subject to dismissal if they violated work hours.

Case 2 cont.  The resident has been nodding off during morning report. You’re concerned because the resident is about to start ‘night float’ and it will be important to finish work in time for the day shift.

Case 3: Dr. Z is performing well clinically but has very low inservice exam scores. Faculty have warned that he will not be promoted to the next level of training if he does not achieve a minimum standard on a repeat exam. He did particularly poorly in the sections on GI and Renal disease, two areas that you have noticed are not well taught.

Case 3 continued  Dr. Z had nearly perfect SAT’s and scored 33 on the MCAT. His USMLE part I score was strong but USMLE II scores were marginal.  Formerly a slave to fashion, he is no longer attentive to his appearance. He often wears scrubs at work and has taken to wearing a ‘play-off’ beard when its still early in the season.

Remember…for struggling residents   Make diagnosis and treatment plan   Include objective assessments   Provide frequent honest feedback   Consult appropriate people, resources, and policies   Involve program director and faculty